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Digitized  by  the  Internet  Archive 
in  2011  with  funding  from 
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http://www.archive.org/details/engravingsofarteOObell 


ENGRAVINGS 


OF  THE 


ARTERIES. 

% 


FINLEY'S  SECOND  EDITION. 


ENGRATINGS 


ARTERIES; 


ILLUSTRATING  THE 


ANATOMY  OF  THE  HUMAN  BODY, 


AND    SERVING   AS 


AN  INTRODUCTION 


SURGERY  OF  THE  ARTERIES. 


Br 
CHARLES  BELL,  Surgeon. 


SECOND  AMERICAN  FROM  THE  THIRD   LONDON  EDITION,  CORRECTED. 

PHILADELPHIA: 
PUBLISHED  BY  A.  FINLEY,  AT  HIS  MEDICAL  BOOK-STORE. 

William  Fry,  Printei-. 
1816. 


■rk 


■     £ 


TO 


SIR  CHARLES  BLICKE, 


SENIOR  SURGEON  OF  ST.  BARTHOLOMEW'S  HOSPITAL. 


^C.  ^c.  ^c. 


PLATES  OF  THE  ARTERIES 

ARE  INSCRIBED, 

AS  A  TRIBUTE  OF  RESPECT  TO  HIS 
PROFESSIONAL  TALENTS,  AND  EMINENT  SKILL  AS  AN  OPERATOR;  AND 
IN  ACKNOWLEDGMENT  OF  HIS  ATTENTION  AND  CIVILITIES  TO 
THE  AUTHOR,  WHILE  YET  A  STRANGER  IN  LONDON. 


J3 


PREFACE 


TO    THE 


FIRST  EDITION. 


To  facilitate  the  acquisition  of  the 
leading  principles  ought  to  be  the  first 
object  of  an  elementary  book,  and  most 
of  all  ought  we  to  study  simplicity  in  a 
work  treating  of  Anatomy.  When  the 
way  is  smoothed,  the  student  feels  a 
rapid  progress,  and  is  pleased  with  his 
own  exertions;  and  it  requires  only  a 
little  self-examination  to  be  assured  that 
much  of  our  partiality  for  any  particular 


424263 


8 

line  or  object  of  study,  often  results  from 
a  real  or  fancied  superiority  of  know- 
ledge; perhaps  in  Anatomy,  more  than 
in  any  other  pursuit,  it  is  necessary  to 
make  the  student  sensible  of  his  pro- 
gress, before  he  can  feel  any  thing  like 
enthusiasm,  or  even  partiality  for  it. 

It  is  upon  the  simplicity  of  these 
Plates,  therefore,  more  than  upon  their 
elegance,  or  their  accuracy,  (though  I 
am  confident  that  in  this  last  respect 
they  are  not  deficient,)  that  I  would 
place  their  merit.  When  the  importance 
of  the  study  of  the  Arteries  is  consid- 
ered— a  point  so  fully  enforced  and  il- 
lustrated in  the  volume  of  the  text  to 
which  I  mean  these  plates  to  be  attach- 


ed — this  book  must,  I  think,  be  an 
acquisition  to  the  student,  since  I  am 
conscious  that  I  should  myself  have 
found  it  to  be  so  in  the  commencement 
of  my  studies;  it  is  with  this  feeling  that 
I  offer  it  with  confidence  to  the  public. 
I  am  assured,  also,  that  the  study  of  the 
Blood-vessels  and  Nerves  from  Plates, 
prepares  us  better  for  undertaking  any 
surgical  operation  than  that  of  bare 
description,  however  accurate,  however 
simple,  or  however  constantly  the  true 
practical  inferences  may  be  kept  in 
view.  It  is  upon  the  eye  that  the  impres- 
sion must  be  made,  which  is  to  enable 
us,  in  looking  upon  a  limb,  to  mark  the 
course  of  the  Arteries:  Drawings  are  a 
kind  of  notes,  too,  more  easily  consult- 


10 

ed;  and  bring  to  the  mind,  in  a  more 
lively  manner,  all  that  was  associated 
in  our  first  studies. 


In  following  the  course  of  the  Ar- 
teries we  must  have  continual  occasion 
to  observe,  that  if  one  branch  deviate 
from  the  more  general  course,  or  be 
of  an  unusual  size,  the  neighbouring 
branches  have  also  an  unusual  form. 
In  the  arteries  of  the  arm,  for  example, 
were  we  to  observe  the  great  Thoracic 
Artery  of  an  uncommon  size,  and  send- 
ing large  branches  under  the  Latissi- 
mus  Dorsi,  and  under  the  Scapula;  were 
we  to  take  our  drawings  of  this  Artery 
as  an  example  of  a  beautiful  distribution 


11 

of  the  external  Mammary  Artery,  with- 
out attending  to  the  effect  of  such  dis- 
tribution on  the  Subscapular  Artery;  or 
again,  were  we  to  draw  the  Subscapular 
Artery  of  the  great  comparative  size 
which  it  not  unfrequently  takes;  we 
should  not  give  a  just  representation  of 
the  natural  and  most  usual  distribution 
of  those  Arteries:  for,  as  we  find  that 
the  distribution  of  the  Thoracic  Ar- 
teries materially  affects  the  distribution 
of  the  Articular  Arteries  and  of  the 
Profunda,  although  it  be  absolutely 
necessary  in  the  text  to  describe  the  size 
and  importance  of  this  Artery,  because 
in  our  operations  at  this  part  we  must 
keep  in  view  the  more  dangerous  and 
unfavourable  circumstances,  it  does  not 


12 

follow  that  we  are  to  make  our  drawings 
by  the  same  rule;  we  should  by  doing 
so  make  them  monstrous  and  unna- 
tural. 

We  thus  see  the  necessity  of  combi- 
ning drawing  with  description.  In  the 
latter  we  mark  all  the  variety  of  dis- 
tribution, and  the  peculiarities  of  each 
branch  considered  individually;  but 
this  again  naturally  produces  intricacy, 
unless,  by  comparison  with  the  draw- 
ings, and  their  short  explanations,  we 
can  take  a  rapid  and  general  view  of 
the  course  of  the  vessels.  The  drawings 
ought,  therefore,  to  give  the  represent- 
ation of  the  more  general  distribution, 
while  the  varieties  and  peculiar  forms 


13 

are  left  to  description.  And  here  comes 
a  question  of  some  consequence — How 
is  a  selection  from  the  great  variety  of 
distribution  of  the  vessels  and  nerves 
of  the  body  to  be  made? 

I  am  very  averse  from  the  ideas 
most  prevalent  regarding  Anatomical 
Tables,  that  it  is  impossible  to  make  a 
true  representation  of  the  parts  from 
any  individual  body;  for,  as  we  see,  in 
looking  over  the  variety  of  Anatomical 
Tables,  that  those  which  have  the  cha- 
racters of  the  parts  distinctly  marked, 
and  have  been  evidently  drawn  from 
the  parts  dissected  and  laid  out  before 
the  artist,  are  in  greatest  esteem  for 
the  accuracy  of  the  anatomy,  and  best 


14 

bear  the  only  true  test  of  excellence, 
the  immediate  comparison  with  the 
subject  in  the  dissecting  room;  so,  on 
the  other  hand,  those  made  by  first 
drawing  the  outlines  of  the  parts,  and 
then  the  vessels,  are  plans  merely,  in 
which  the  character  of  the  parts,  and 
the  peculiar  course  and  turnings  of  the 
vessels,  are  lost. 

But  I  hope  I  shall  not  be  understood 
to  say,  that  if  a  drawing  be  made  ac- 
curately from  the  subject,  it  will  there- 
fore answer  all  the  purposes  required. 
Of  twenty  bodies,  not  one,  perhaps, 
will  be  found  fit  for  drawing;  but  still 
I  conceive  that  we  are  not  to  work  out 
a  drawing  by  piecing  and  adding  from 


15 

notes  and  preparations;  we  are  to  select 
carefully  from  a  variety  of  bodies,  that 
which  gives  largeness  of  parts,  where 
the  characters  of  parts  are  well  mark- 
ed, and  where  there  is  the  most  natural 
and  usual  distribution  of  vessels.  In 
making  our  drawings  of  such  dissec- 
tions, let  us  allow  ourselves  no  license, 
but  copy  accurately.  By  noting  in  the 
description  any  little  deviation,  every 
necessary  end  is  answered. 

By  long  attention  to  the  subject,  I 
hope  that  I  have  been  able  to  make 
these  Plates  simple,  intelligible,  and 
accurate.  While  the  design  of  this  book 
of  Plates  is  to  present  to  the  student, 
at  one  glance,  the  general  distribution 


16 

of  the  vessels,  and  to  fix  them  in  his 
memory  in  a  way  which  no  descrip- 
tion can  accomplish,  it  will  be  found  to 
give  the  most  usual  distribution  of  the 
branches;  for  I  have  been  careful  in  the 
selection  of  my  subjects. 

In  studying  the  Arteries,  or  any  part 
of  Anatomy,  we  should,  in  the  first 
place,  run  the  eye  over  the  corres- 
ponding plate,  then  read  the  general 
description  in  the  text;  and  lastly, 
proceed  to  study  more  closely,  step 
by  step. 

I  know  the  difficulties  which  the 
student  must  encounter  in  acquiring 
a    comprehensive    knowledge    of    the 


17 

nerves;  the  books  on  that  subject  be- 
ing more  confused  and  intricate  to 
study,  than  the  most  irregular  dissec- 
tion. The  next  part,  therefore,  of  this 
work,  comprehends  the  Nervous  Sys- 
tem, though  the  present  book  I  con- 
ceive to  be  complete  in  itself. 


PREFACE 


TO    THE 


SECOND  EDITION. 


In  this  edition,  I  trust,  I  have  shown 
my  regard  for  the  approbation  of  the 
public,  already  bestowed  upon  this  little 
work,  by  endeavouring  to  improve  it. 

I  have  added  a  Plate  of  the  Aortic 
System,  by  my  young  friend  and  pu- 
pil, Mr.  Charles  Cheyne,  whose  steady 
pursuit  of  that  science  to  which  I  am 
devoted,  has   gained  my  esteem   and 


20 

confidence.  I  have  added  some  other 
Plates,  in  illustration,  as  of  the  foot, 
hand,  and  jaw,  where  I  thought  the 
smallness  of  the  original  scale  preclu- 
ded the  possibility  of  fully  disclosing 
the  anatomy. 

I  have  also  added  some  schemes  of 
arrangement,  of  the  more  intricate 
branches,  in  foot  notes. 

The  most  essential  addition,  how- 
ever, which  I  have  made,  is  the  intro- 
duction of  some  rules  for  cutting  down 
upon  the  Arteries,  in  cases  of  dangerous 
bleedings.  They  were  taken  by  a  pupil, 
from  my  public  lectures  on  the  Ar- 
teries, when  I  had  the  subject  before 


21 

me,  and  was  describing  and  measuring 
the  depth  of  parts,  previous  to  my 
entering  upon  the  rules  deduced  from 
the  projecting  points  of  bone,  and  the 
course  of  the  tendons  and  muscles  in 
the  living  body. 


London, 

Leicester  Street,  Leicester  Square. 


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EXPLANATION 


PLATE  I. 


FORE  AND  BACK  VIEWS  OF  THE  HEART. 


FIG.  I. 

(See  Wistar's  Anatomy.,  Vol.  II.  fi.  SO — 61.) 

Ji  vieiv  of  the  Heart,  nearly  in  the  Situation  in 
which  it  is  seen  when  the  Breast  is  opened. 

A.  The  Superior  Vena  Cava,  returning  the  blood 

from  the  head  and  arms. 

B.  The  Inferior  Cava,  tied  where  it  pierces  the 

diaphragm  to  convey  the  blood  from  the 
lower  parts  of  the  body  into  the  right 
auricle. 


24 

c.  The  His^ht  Sinus,  or  Auricle. 

D.  Tlie  Iiiu;ht  Ventricle. 

E.  The  Fnlmonary  Artery;  it  is  seen  to  divide; 

one  branch  to  pass,  under  the  arch  of  the 
aorta,  to  the  lungs  of  the  right  side;  the 
other  to  take  an  acute  turn  to  those  of  the 
left  side. 

F.  The  top  of  the  Left  Sinus  of  the  Heart,  or 

that  which  is  properly  the  auricle. 

G.  The  Left  Ventricle;  it  is  seen  Fig.  II.  A. 
H.  The  Arch  of  the  Aorta. 

I.  The  Subclcn'ian  and  Carotid  of  the  right  side, 

rising  together  from  the  Aorta. 
K.  The  Carotid  Artery  of  the  left  side. 
L..  The  SubclaTian  Artery  o^  the  \eh  side. 
M.  A  Branch  of  the  Right  Coronary  Artery. 
N.  The  Left  Coronary  Vein, 
o.  A  Branch  of  the  Coronary  Vein. 


25 


FIG.  II. 

The  Arteries  and  Veins,  which  are  attached  to 
the  Spine,  are  seen  in  this  View, 

A.  The  Left  Ventricle  of  the  Heart. 

B.  The  Trunk  of  the  Pnljnonary  Artery. 

c.  The  Riglit  Branch  of  the  Pulmonary  Artery. 

D.  The  Left  Branch  of  the  Pulmonary  Artery. 

E.  The  Buds  of  the  Pulmonary  Veins  of  the 

left   side,  entering  the  left  sinus  of  the 
heart. 

F.  The  Pulmonary  Veins  of  the  right  side. 

G.  The  Vena  sine  Pari,  or  Azygos;  this  vein  lies 

upon  the  spine,  collects  the  blood  from  the 

back  part  of  the  thorax,  and  conveys  it  to 

the  superior  vena  cava. 
H.  The  Superior  Vena  Cava. 
I.  The  Aorta,  where  it  first  touches  the  Spine. 
L.  The  Left  Carotid  Artery, 
M.  The  Left  Subclavian  Artery. 
N.  The  Arteria  Innominata,  or  common  origin 

of  the  subclavian  and  carotid  of  the  right 

side. 

D 


SCHEME  ,>tOi^  ARTERUL  SYSTEM. 


•  Xm^tStth  .tKmi^  i 


EXPLANATION 


PLATE  OF  THE  AORTIC  SYSTEM. 


(Wistar's  Anatomy,  Vol.  II.  Page  238 — 300.) 

Branches  of  the  Arteries. 


Principal  Divisions  of  the 
Arteries, 

A.  Values  of  the  Aorta. 

B.  The  Ascending  Aorta 


[ 


1.  The  Left  Coronary  Artery. 


2.  The  Right  Coronary  Artery. 

c.  The  Arteria  Innominata.* 

f  1.  The  Vertebral  Artery. 
I 

2.  The  Internal  Mammary. 

3.  The  Lower  Thyroid  Artery. 

4.  The  Ascendant  Branch  of  the 
Thyroid. 

5.  The  Transversalis  Colli. 

6.  The  Transversalis  Humeri. 

7.  The  First  and  Second  Intercos- 
tal s. 

(^8.  The  Suprascapularis. 

*  The  Arteria  Innominata  commonly  divides  into  the  Right  Carotid  ami 
Subclavian,  but  here  the  Left  Carotid  also  is  given  from  it. 


D.  D.  The  Subclavian        <^ 


28 


Princijiul  Divisiona    of  the 
Arteries. 


K.  E.  Axillary  Artery 


F-  v.The Brachial  Artery* 


G.  The  Radial  Artery        <^  2. 
13. 
1. 


H.  The  Ulnar  Artery         < 


I.  Interosseoiis  Artery 


K.  Carotid  Arterif, 


2. 
3. 

u. 


L.  External  Carotid  <. 


Bra  nc  he  a  of  the  Arteries. 

Superior  Thoracic  Artery. 
Thoracica  Longior. 
Thoracica  Humeraria. 
Subscapularis. 
Circumflexa  Posterior. 
Circumflexa  Anterior. 

Profunda  Humeri  Superior.! 
Anastomoticus  Major. 

Recurrens  RacUalis  Anterior. 
Arteria  Superficialis  Volae. 
Arteria  Palmaris  Profunda. 
Recurrens  Ulnaris  Anterior. 
Recurrens  Uhiaris  Posterior. 
Arteria  Dorsalis  Ulnaris. 
Arteria  Palmaris  Profunda. 

Interossea  Superior  Perforans. 
Recurrens  Interossea. 

Arteria  Thyroidea  Superior. 
Arteria  Lingualis. 
Arteria  Labialis  vel  Facialis. 
Arteria  Occipitalis. 
Posterior  Auris. 
Arteria  Maxillaris  Interna. 
Arteria  Transversalis  Faciei. 
Arteria  Temporalis. 


*  On  the  left  side  there  is  a  high  bifurcation  of  this  Artery, 
f  The  Lesser  Profunda  is  seen  at  16,  Plate  VI. 


^w^. 


29 


Principal  Divisions  of  the 
Arteries. 

M.  Internal  Carotid 

N.  Vertebral  Artery 

o.  Basilar  Artery 
p.  Thoracic  Aorta 


Branches  of  the  Arteries. 


Q.  Abdominal  Aorta 


R,  Common  Iliacs. 


s.  Internal  Iliac 


C\.  Arteria  Anterior  Cerebri. 

t2.  Arteria  Media  Cerebri. 
3.  Arteria  Communicans. 
*  Arteria  Cei-ebelli  Posterior  and 
Anterior. 

{1.  Arteria  Communicans. 
2.  Arteria  Cerebri  Posterior. 
1  to  10.  Arteriae  Intercostales.r 

1.  Arteria  Phrenica. 

2.  Arteria  Coeliaca. 

3.  Coronai-ia  Ventriculi. 

4.  Arteria  Hepatica. 

5.  Arteria  Splenica. 

6.  Mesenterica  Superior. 

7.  Arteriae  Capsularis. 

8.  Arteriae  Emulgentes. 

9.  Arteriae  Spermaticae. 

10.  Mesenterica  Inferior. 

1 1 .  Arteriae  Lumbares. 

12.  Arteriae  Media  Sacra. 

• 
f  1 .  Arteria  Obturatoria. 

2.  Arteria  Glutea. 

3.  Arteria  Ischiadica. 
.4.  Arteria  Pudica. 


*  For  the  Arteries  of  the  Cerebellum,  see  Plate  V.  10, 11, 12. 

■j-  The  Aorta,  when  it  is  behind  the  root  of  the  lungs,  gives  three  or  four 
arteries  to  nourish  their  substance,  called  Bronchial  Ai'teries.  Lying 
beside  the  oesophagus,  also,  it  gives  to  it  a  few  arteries,  the  oesophagial 
arteries. 


30 

Princifial  Divisions  of  the  Branches  of  the  Arteries. 

Arteries. 
T.  External  Iliacs. 

1.  Arteria  Epigastrica. 

2.  Circumflexa  Ilii. 

u.  Femoral   I  ^ ,    circumflexa  Externa. 

Artery    ^  ,' 

I  3.  Profunda  Femoris<J  -2-  Circumflexa  Interna. 

I  Is.  Perforantes. 


V.  Pojiliteal 
Artery 


1.  Arteria  Articularis  Superior  Externa. 

2. Interna. 

<(  3 Media. 

4. Tnl'erior  Externa. 

3. — Interaa. 


C\.  Recurrens  Tibialis  Anticae. 

I  2.  Mallcolaris  Interna. 
x.  Anterior  Tibial  Artery< 

3. Externa. 

L4.  Arteria  Tarsea. 

.  Plantaris  Externa. 
Y.  Posterior  Tibial  Artery  < 

'  '"  Interna. 


Anterior. 

z.  Fibular  Artery  ,  „    r. 

'  "   Posterior. 


{1.  Plants 
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EXPLANATION 


PLATE  11. 


E.jcplaining  the  JDiaphragm,  the  Situation  of  the 
Heart,  the  Blood-vessels  of  the  Breast,  and  the 
Mdominal  Aorta, 

(Bell's  Anat.  Vol.  II. pages  245 — 252,  and 408.) 
(Wistar,  pages  258 — 261,276 — 277,  280, and  285.) 

A.  The  Llaphragm,  dividing  the  thorax  from 

the  abdomen.* 

B.  The  Heart,  l^ing  upon  the  diaphragm,  and 

with  the  apex  obliquely  to  the  left  side.f 

*  A  thrust  made  with  a  small  sword  on  the  left  side  of  the 
chesf,  immediately  above  the  seventh  rib,  perpendicularly  to 
the  convexity  of  the  chest,  will  pass  through  the  diaphragm 
into  the  stomach,  the  heart  escaping.  Jf 

t  A  thrust  immediately  above  the  left  pap,  and  above  the 
fifth  rib,  perpendicularly  to  the  surface  of  the  chest,  transfixed 


32 

c.  The  Bight  Auricle. 

D.  The  Left  Auricle;  that  which  receives  the 

blood  from  the  lungs. 

E.  The  Superior  Vena  C*«t'«,  returning  the  blood 

from  the   arms   and   head   to    the   right 
auricle. 

the  body  of  the  left  ventricle  of  the  heart,  perforating  the  ante- 
rior and  extreme  margin  of  the  right. 

A  thrust  made  perpendicularly  to  the  convexity  of  the  chest, 
immediately  under  the  anterior  head  of  the  fifth  rib,  will  pass 
through  the  anterior  edge  of  the  right  lung,  and  pierce  the 
apex  of  the  heart. 

Perpendicularly  to  the  convexity  of  the  right  side  of  the 
chest,  and  immediately  below  the  anterior  head  of  the  third  rib, 
the  thrust  made  will  pierce  the  lungs  and  mediastinum,  and 
pass  through  the  right  auricle. 

A  thrust  perpendicularly  down  by  the  left  side  of  the  ster- 
num, betwixt  the  fourth  and  fifth  ribs,  will  pass  through  the 
upper  part  of  the  heart,  near  the  root  of  the  pulmonary  artery. 

A  thrust  perpendicularly  to  the  convexity  of  the  chest,  im- 
mediately under  the  right  pap,  and  of  course  the  fifth  rib,  will 
pass  through  the  root  of  the  lungs  among  the  great  vessels. 

A  thrust  with  the  small  sword,  horizontally  from  the  greatest 
lateral  convexity  and  upper  edge  of  the  seventh  rib,  will  pass 
through  the  middle  of  the  lower  portion  of  the  posterior  lobe 
of  the  right  lung,  behind  the  heart,  into  the  posterior  mediasti- 
num, where  the  aorta  and  oesophagus  are  about  to  pass  through 
the  diaphragm. 


33 

F.  The  Srch  of  the  Aorta.* 

G.  The  Pulmonic  Artery. 

H.  H.  The  Right  and  Left  Carotid  Artery. 

I.  The  Subclavian  Artery. 

K.  The  Internal  Mammary  Artery. 

L.  The   Thyroid  Artery,  to  the  shoulder,  the 

neck,  and  the  thyroid  gland. 
M.  The  Vertebral  Artery. 
N.  The  Lungs  of  the  right  side, 
o.  The  Perforation  of  the  Diaphragm,  for  the 

transmission  of  the  inferior  cava, 
p.  The  Hole  by  which  the  CEsophagus  passes 

into  the  abdomen. 
Q.  The  Lesser  Muscle  of  the  Diaphragm.  See 

the  text,  p.  325,  Vol.  II. 

*  The  arch  of  the  aorta  lies  three  fourths  of  an  inch  below 
the  level  of  the  upper  part  of  the  sternum. 

If  the  assassin  strikes  within  the  clavicle,  obliquely  down,  with 
the  stiletto,  the  point ^jvill,  at  the  depth  of  ,  pass  into  the 

arch  of  the  aorta,  and  occasion  a  more  sudden  death  than  if 
struck  into  the  heart;  if  the  aorta  should  escape,  some  of  the 
great  branches  will  be  wounded;  even  if  the  great  branches 
should  escape,  and  the  trachea  be  wounded,  the  patient  is  in 
danger  of  instantaneous  death,  from  the  blood  passing  into  the 
trachea  suffocating  him. 

E 


34 

11.  s.  The  whole  length  of  the  Abdominal  Aorta. 
It  is  seen  embraced  by  the  diaphragm  at 
R.,  and  immediately  giving  off  the  phrenic 
and  cceliac  arteries. 

1.  The  Right  Phrenic  Artery. 

2.  The  Left  Vhvenic  Artery. 

3.  The  Root  of  the  Cceliac  Artery^  (See  Plate 

YII.) 

4.  4.  The  Upper  Mesenteric  Artery,  (See  Plate 

VIII.) 

5.  5.  The  Emulgent  Arteries. 

6.  The  Loiver  Mesenteric  Artery. 

7.  The  Hcemorrhoiilal  Artery,  a  branch  of  the 

last. 
8.8.  The  Common  Iliac  Arteries. 
9.  The  Internal  Iliac.  It  is  seen  to  give  off  the 

gluteal,  the  ischiatic,  and  obturator  artery. 


I'hld  III. 


■^- 


J^-'x:^- 


"■-u 


%  %.  p^^-y 


/. /?<(//  /A/. 


f?.  t^-Wif 


AiMV/i.i  /V</,  iHk'  h  Ifinley  fJulad." 


EXPLANATION 


OF 


PLATE  III. 


This  and  the  following  Plate  illustrate  the  Tecct 
of  Bell,  from  pages  242 — 294;  and  Wistar, 
pages  241 — 254. 

A.  The  Common  Carotid  Artery.* 

*  To  cut  down  for  this  artery,  I  would  turn  the  chin  towards 
the  same  side,  and  then  make  an  incision  two  inches  and  a  half 
in  length  along  the  anterior  edge  of  the  sternoid  portion  of  the 
cleido  mastoideus.  In  doing  this,  the  firm  cellular  membrane, 
and  some  of  the  anterior  fibres  of  the  platysma  myoides  must 
be  cut.  Having  fairly  laid  bare  the  edge  of  the  mastoideus,  we 
ought  to  do  no  more  with  the  edge  of  the  knife;  we  ought  then 
to  hold  aside  the  mastoideus,  and,  with  the  fingers  and  handle  of 
the  knife,  we  dig  down  to  the  artery,  and  insulate  it:  We  find  a 
small  muscle,  the  omo-hyoideus  passing  obliquely  over  the  arte- 
ry, about  an  inch  and  a  half  from  the  head  of  the  clavicle.  The 


36 

B.  The  Internnl  Carotid  Artery,  or  Artery  of  the 

Cerehruin.* 
c.  Tlie  EjL'ternal  Carotid  Artery. 

D.  The  Lower  Thyroid  Artery,  being  a  branch 

of  the  Subchivian  Arterj.f 

E.  The   Upper  Thyroid  Artery,  being  the  first 

branch  of  the  Carotid.J 

great  internal  jugular  vein  is  close  on  the  outside  of  the  artery, 
the  par  vagum  betwixt  them,  the  sympathetic  nerve  below,  and 
close  upon  the  vertebrae.  If  a  small  nerve  be  observed  running 
above  the  artery,  it  is  the  descendens  noni. 

If  vessels  bleed  in  making  this  incision,  they  are  muscular 
branches  of  the  thyroid  artery. 

*  Internal  Carotid  lacerated. — Abernethy*s  Surg.  Obs. 

t  The  Inferior  Thyroid  lies  in  a  situation  not  to  be  tied.  It 
lies  near  the  side  of  the  vertebrae,  where  it  is,  on  the  outer  side 
of  the  carotid  artery,  fully  five  fingers  breadth  from  the  clavicle. 
It  should  be  sought  for  directly  under  the  omo-hyoideus,  and 
betwixt  the  carotid  and  the  anterior  edge  of  the  scaleni.  It  can- 
not be  taken  up  there.  In  cutting  for  it,  I  cut  the  sympathetic, 
and  probably  the  phrenic  nerve.  It  would  be  better  to  endea- 
vour to  reach  the  artery,  by  turning  over  the  side  of  the  gland 
which  lies  before  the  carotid  trunk.  By  thus  stretching  the 
gland,  we  find  the  artery  as  if  descending  from  above,  in  two 
branches,  to  the  lower  part  of  the  gland. 

\  It  may  be  proposed,  previous  to  the  attempt  of  extirpating 
the  thyroid  gland,  to  tie  the  four  arteries  which  supply  it.  We 


BRANCHES  OF  THE  EXTERNAL 
CAROTID  ARTERY. 

1.  The  Lingual  Artery,* 

2.  The  Fascial  Artery  or  Labial  Artery.-f 

3.  The  Suhmental  Artery. 

4.  The  Upper  and  Lower  Coronary  Arteries. 

5.  The  Inosculations  of  the  extreme  Branches 

of  the  Fascial  x\rtery,  with  the  Ophthalmic 
Artery, 

cannot  reach  the  inferior  thyroid  artery  before  it  has  passed 
under  the  carotid:  The  only  possible  way  is,  to  lift  up  the  infe- 
rior lobe  of  the  tumour,  separating  the  carotid  from  it;  when 
we  find  the  inferior  thyroid  artery  rising  in  two  branches,  to  be 
distributed  to  the  gland.  It  would  appear  that  these  branches 
were  descending  from  the  carotid,  by  the  acute  turn  they  take 
downwards  from  their  highest  point  on  the  neck. 

*  The  Lingual  Artery  makes  its  great  curve  (being  tor- 
tuous) immediately  above  the  great  horn  of  the  os  hyoides; 
it  then  passes  under  the  mylo-hyoideus.  Were  it  ever  necessary 
to  cut  upon  it  here,  let  the  extreme  point  of  the  os  hyoides  be 
the  mark;  for  it  turns  just  above  it  to  pass  under  the  mylo- 
hyoideus. 

t  Fascial  Artery,  or  Labialis,  or  Maxillaris  Externa,  or  An- 
gularis,  often  tortuous  before  rising  over  the  jaw.  This  artery 


38 

6.  The  Occipital  Artery.* 

7.  The  place  where  it  frequently  sends  down 

inosculations  to  the  vertebral  artery. 

8.  The  Lesser  Posterior  Artery  of  the  Ear. 

9.  A    Branch    sometimes     called     Posterior 

Temporal  Artery. 

10.  Posterior  Artery  of  the  Ear. 

11.  The    continued  Branch   of  the    External 

Carotid,  or  sometimes  the  Temporal  Ar- 
tery; it  divides  into  the  submaxillary  and 
proper  temporal  artery. 

12.  The   Internal  MaoLillary  Jirtery.  See  the 

distribution  of  this  artery  in  the  next  Plate, 
fig.  I.  14,  and  fig.  II. 

left  untied  in  operation,  almost   suffocated  the  patient  after- 
wards. See  Abernethy's  Surg.  Observations. 

*  The  Occipital  is  found  immediately  under  the  mastoid 
process,  from  under  the  insertion  of  the  mastoid  muscle;  it 
runs  backwards,  on  a  level  with  the  tip  of  the  ear,  under  the 
insertion  of  the  trapezius,  and,  of  course,  under  the  superior 
transverse  ridge  of  the  occipital  bone,  on  the  side  of  the  neck. 
On  the  side  of  the  neck,  the  internal  jugular  vein  is  immediate- 
ly under  it;  it  is  also  under  the  origin  of  the  digastricus,  and 
under  the  ninth  pair  of  nerves. 


39 

13.  The  Transverse  Artery  of  the  Face.* 

14.  The  Temporal  Artery^  dividiifg  into  anterior 

and  posterior  temporal  arteries.  There  are 
other  branches  less  superficial.  The  deep 
Temporal  is  a  branch  of  the  Internal 
Maxillary. 

*  This  artery  I  have  seen  bleed  very  smartly.  In  cuts  of  the 
face,  when  this  or  any  of  the  other  arteries  of  the  face  are  open- 
ed, we  have  only  to  use  the  twisted  suture,  taking  pains  to  pass 
the  needle  so  near  the  bleeding  orifice  that  it  may  receive  the 
full  operation  of  the  thread  when  twisted  round  the  needle  or 
pin.  This  secures  the  artery,  and  at  the  same  time  brings  the 
lips  of  the  wound  neatly  together. 


Thuen: 


/j/y.  /. 


r^Va.  y. 


>,^f,  ^'•^^.^^^^^^^ „iir:;-' 


(fiAiJ/  ,^eA 


£j^.   L'tAitn     Jnv^ 


I'iiMjIi,/ X,'i'.  M:'  />>■   !. /in/,r  PhiUI :' 


EXPLANATION 


OF 


PLATE  IV. 


{Bell,  242—294.    IVistar,  241 — 254.) 

Being  the  Distribution  of  the  Internal  Carotid, 
the  Vertebral  and  Internal  Maa^illary  Arteries, 
as  seen  upon  making  a  vertical  Section  of  the 
Head. 

FIG.  I. 

A.  The  Upper  Jaw  Bone;  part  of  it  is  torn  away. 

B.  The  Lower  Jaw  Bone;  all  the  angle  of  the 

right  side  is  taken  away,  to  show  the  inter- 
nal maxillary  artery. 

c.  Tlie  Tongue. 

D.  The  Antrum  Highmorianum,  torn  open. 


42 

E.  The  Vertebrte  of  the  Neck,  cut  to  show  the 

passage  of  the  artery,  encased  in  the  bones. 

F.  F.  The   Scull  cap,    sawn  through  exactly  in 

the  length  of  the  longitudinal  sinus. 

G.  The  Falx,  which  divides  the  hemispheres  of 

the  Brain. 

H.  The  Longitudinal  Sinus. 

I.  The  Fourth  Sinus,  returning  the  blood  from 
the  lower  sinus  of  the  falx,  and  from  the 
vena  galeni. 

K.  Right  Lateral  Sinus. 

L.  The  Tentorium,  which  covers  the  cerebel- 
lum, and  supports  the  posterior  lobes  of 
the  cerebrum. 

ARTERIES. 

1.  The  Common  Carotid  Jlrtery. 

2.  The  Internal  Carotid  Artery.^ 

*  Internal  Carotid.  In  Dr.  Hooper's  collection  of  prepara- 
tions, there  is  a  curious  example  of  the  ulceration  of  this 
artery.  A  man  intending  to  destroy  himself,  attempted  to  swal- 
low pins  tied  together;  they  stuck  in  the  pharynx,  and  in  time 
penetrated  to  this  artery,  which  suddenly  cut  him  off". 


43 

3.  The  Ea^ternal  Carotid  Artery. 

4.  The  Vertebral  Artery;  the  processes  of  the 

vertebrae  being  cut  away. 

5.  The  last  and  violent  turn  of  the  Vertebral 

Artery,  before  entering  the  foramen  mag- 
num of  the  occipital  bone. 

6.  The  violent    contortions    of  the   Internal 

Carotid  Artery,  before  entering  the  scull. 

7.  The  point  of  the  Internal  Carotid  Artery, 

where,  after  making  its  turns  in  its  pas- 
sage through  the  bone,  it  appears  by  the 
side  of  the  sella  turcica.  See  Plate  V.  1. 

8.  The  Ophthalmic  Artery,  derived  from  the 

carotid.  It  is  this  artery  which  is  seen  to 
inosculate  with  the  Fascial  artery,  in  the 
preceding  Plate,  at  5. 

9.  The  Thyroid  Artery. 

10.  The  Lingual  Artery. 

11.  The  Fascial  Artery  cut  short;  it  is   seen  in 

third  Plate,  fig.  2,  passing  over  the  jaw. 

12.  The  Continued  Trunk  of  the  External  Ca- 

rotid Artery;  it  is  about  to  divide  into  the 
temporal  and  internal  maxillary  arteries. 
See  the  precedin«;  Plate  (11.) 


44 

13.  Tlie  Temporal  Artery^  cut  short. 

14.  The  Internial  Maccillary  Artery. 

15.  That  Branch  of  the  Internal  Maxillary  Ar- 

tery, which  passes  into  the  lower  jaw. 

16.  The   Great  or  Middle  Artery  of  the  Dura 

Mater;  a  branch  of  the  internal  maxillary.* 

17.  The  Artery  of  tlie  Upper  Jaw. 

18.  The  Infra  Orbital  Artery;  it  is  seen  to  pass 

out  upon  the  face. 

*  It  is  this  artery  which  rises  through  the  spinous  hole  in  the 
sphenoid  bone,  and  then  runs  on  the  lower  angle  or  spinous  pro- 
cess of  the  parietal  bone:  here  it  generally  lies  in  a  deep  chan- 
nel, and  gives  occasion  to  a  kind  of  rule  in  surgery,  to  avoid 
applying  the  trephine  at  this  part. 


45 
EXPLAIN  ATION  OF  FIG.  11. 

(5e//,  278—86.    Wistar,  247—251.) 

This  is  a  Plan  of  the  IXTERXJLL  MAXIL^ 
LARY  ARTERY. 

1.  The  Meningeal  Artery^    or    great    middle 

artery  of  the  dura  mater.* 

2.  The  Lower  Mamillary  Artery.f 

3.  Irregular  Arteries:  the  Ptei^ygoid  Arteries. 
5.  The  Deep  Liternal  Temporal  Artery. 

*  This  artery  enters  the  scull  by  the  foramen  spinale  of  the 
sphenoid  bone,  and  is  the  same  that  makes  the  deep  furrow  in 
the  inside  of  the  parietal  bone.  Mr.  Walker,  of  Edinburgh,  com- 
municated a  case  where  an  arrow  shot  into  the  scull  wounded 
this  artery. 

t  Lower  Maxillary.  This  artery  enters  at  the  posterior  fora- 
men of  the  lower  jaw-bone,  and  courses  within  the  bone,  and 
appears  on  the  chin,  coming  out  through  the  mental  foramen. 
See  Ofi.  Surgery^  on  the  bleeding  of  small  arteries  from  bone. 
In  pulling  the  last  molaris  of  the  lower  jaw,  if  the  inner  plate 
of  the  bone  be  broken  ofF,  and  this  artery  to:  n  up  among  the 
cells  of  the  bone,  the  patient  may  die  of  bleeaing. 


46 

6.  The  Artery  of  the  Cheek. 

7.  The  Artery  of  the  Upper  Jaw. 

8.  Tlie  Infra  Orbital  Artery. 

9.  The  Upper  Palatine  Artery, 

10.  The  Orighi  of  the  Upper  Pharyngeal 
Artery. 


/%U,' 


t 


1(1^1! 


l'./.^'.//  M. 


C f^  ^yi^lf'ft    .^t/A7. 


/^iM-M  .Vt'i:  hiA'  />v  .-/.N/i/i-y  r/i/M' 


EXPLANATION 


OF 


PLATE  V. 


ARTERIES  OF  THE  BRJilJ^, 

(^Bell,  Vol.  II.  pages  295—317.    Wistar,257-^'26l.) 
DIVISIONS  AND  EMINENCES  OF  THE  BRAIN. 

A.  A.  The  Anterior  Lobes  of  the  Cerebrum. 

B.  B.  The  Middle  Lobes  of  the  Cerebrum. 

c.  c.  The   Posterior  Lobes   of  the  Cerebrumy 
which  rest  upon  the  tentorium. 

D.  The  Right  and  Left  Lobes  of  the  Cerebel- 

lum. 

E.  The  Medulla  Oblongata, 

F.  Tiie  Optic  JSTerves,  cut  at  their  union. 


48 

G.  The  Corpora  Jilhicantia;  the  Infnndibuhim  is 
seen  betwixt  these  and  the  optic  nerves. 

H.  H.  The  Crura  Cei'ebri. 

I.  The  Forts  Varolii,  or  Tu!)erciilum  Annulare. 

K.  The  Eminences  of  tlie  Medulla  Oblongata, 
called  Corpora  Pyramidalia, 

JL.  The  Corpora  Olivaria, 

artehies. 

1.  2.  The  Right  and  Left  Carotid  Arteries, 
raised  with  the  brain,  and  cut  oft'  as  they 
rise  at  the  point  marked  in  the  preceding 
Plate  (7);  that  is,  as  they  rise  at  the  side 
oftlie  sella  turcica. 

3.  4.  The  Right  and  Left  Vertebral  Arteries, 

5.  The    Union   of   the   Vertebral  Arteries   to 

form  the  Basilar  Artery. 

6.  The  Communicating  Artery,  or  Anastomo- 

sis, betwixt  the  Basilar  Artery  and  Carotid. 

7.  The  Union  of  Comniunication  betwixt  the 

carotids  of  each  side  by  the  anterior  arte- 
ries of  the  cerebrum;  these  anastomoses 
6  and  7  form  the  Circle  of  Willis. 


49 


DIVISIONS  OF  THE  INTERNAL  CAROTID 
ARTERY. 

8.  The  Middle  Jlrtery  of  the  Brain  passing  into 

the  Fissura  Silvii. 

9.  The  Anterior  Artery  of  the  Cerehrum. 


BRANCHES  OF  THE  VERTEBRAL  AND 
BASILAR  ARTERIES. 

10.  The  Posterior  Artery  of  the  Cerebellum  from. 

the  Vertebral  Arteries. 

11.  Avery  considerable  branch  of  the  Basilar 

Artery  to  the  pons  varolii  and  cerebellun^^ 
which  however  has  no  name. 

12.  The  Anterior  Ar^tery  of  the  Cerebellum, 

13.  The  Posterior  Artery  of  the  Cerebrum. 
The  lesser  branches  of  vessels  seen  in  this 

Plate  are  mentioned  in  the  text,  but  are 
not  distinguished  by  any  particular  name. 


b 

^ 


V.l  m'lf/ 


EXPLANATION 


PLATE  VI. 


{Bell,  pages  340—402.    W^'is^ar,  264— 273.) 

OF  THE  JIRTERIES  OF  THE  JiRM. 
FIG.  I. 

A.  The  Scapula. 

B.  The  Pectoral  Muscle  held  up. 
c.  The  Beltoid  Muscle. 

D.  The  Biceps  Muscle. 

E.  The  Coraco-brachialis  Muscle. 

F.  The  Triceps  ea^tensor  Muscle, 

G.  The  Te7'es  Major. 

H.  The  Tendon  of  the  Lesser  Fectoral  Muscle. 
I.  The  Supinator  Lon^us. 


52 

K.  The  EiVtensor  Carpi  RadiaUs. 

L.  The  Tlejcov  Carpi  Ulnaris. 

M.  The  Palmaris  Longiis  and  Flea^or  Muscles 
of  the  Fingers. 

From  the  Aorta  till  the  Artery  passes  over  the 
first  rib,  it  is  called, 

1.  The  Suhclariaii  Artery.  When  this  artery  is 
injected,  and  tolerably  full,  it  makes  two 
pretty  acute  turns,  in  the  form  of  an  italic 
8,  before  it  escapes  under  the  clavicle.  Its 
larger  curve  is  just  where  it  comes  through 
the  anterior  and  middle  portions  of  the 
Scalenus  muscle.  It  then  descends  directly 
ac^ross  the  first  rib.  It  then  comes  out 
under  the  clavicle,  three  fingers  breadth 
from  the  inner  extremity  of  the  clavicle. 
Just  at  this  point,  viz.  w  here  it  passes  over 
the  bulging  of  the  rib,  it  may  be  com- 
pressed in  the  living  body.*  Its  branches 
are. 


*  To  cut  for  the  Subclavian  Artery,  beg-in  the  incision  an  inch 
from  the  inner  head  of  the  clavicle;  then  carry  it  in  a  direction 
slightly  deviating  from  the  line  parallel  with  the  clavicle,  to- 


53 

2.  The  Internal  Mammm^y  Artery.* 

3.  The  Vertebral  Arter  . 

4.  The  Thyroid  Artery, 

5.  The  Ascending  Thyroid  Artery,  a 
branch  of  the  last.  The  Transversa- 
lis  Colli  is  also  generally  a  branch  of 
the  Thyroid,  very  irregular  in  its 
origin.  Sometimes  it  comes  from  the 
Thyroid,  and  then  receives  the  name 
of  Transversalis  Humeri;  sometimes 
it  comes  from  the  place  of  the  CervU 

wards  the  Acromion  Scapulae.  The  second  incision  cuts  the 
fibres  of  the  Pectoralis  Major,  where  they  arise  from  the  clavi- 
cle; here  we  come  upon  a  thick  bed  of  cellular  membrane, 
which  being  lifted,  we  find  the  great  subclavian  vein,  with  the 
cephalic  vein  joining  it;  under  this  vein,  and  a  little  further 
backwards  (more  under  the  clavicle)  the  artery  is  found. 

* Bva.nchesoh\\e  Internal Ma77nnary  jirtery.  l.Tothe  Thymus^ 
2.  Accompanying  the  Phrenic  Nerve.  3.  To  the  Pericardium. 
4.  To  the  Mediastinum.  5.  Several  branches  to  the  Pectoral 
Muscle  and  Mamma.  6.  To  the  Diaphragm.  7.  To  the  Ab- 
dominal Muscles,  inosculating  with  the  Epigastric  Artery. 
If  a  thrust  be  made  with  a  small  sword  in  any  part  (below  the 
second  rib)  in  a  line  parallel  with  the  Sternum,  and  three 
fourths  of  an  inch  from  its  edge,  it  will  wound  the  internal 
Mammary  Artery. 


54 

calis  Superficialis,  or  even  from  the 
Subscapiilaris;   sometimes  from  the 
Subclavian  itself. 
The  Deep  and  Superjicial  Cervical  Avleries. 

6.  I'he  Supra  Scapular  Artery. 
The  Jlailla. 

7.  The  Trunk  now  assumes  the  name  of  Aa7- 

illary  Artery.  Its  branches  are,  three 
or  four  to  the  chest;  three  to  the 
scapula  and  shoulder.* 

8.  The  Lesser  Superior  Intercostal  Artery, 

or  Superior  Thoracic  Artery, 

9.  The  Greater  or  Longer  Thoracic  Artery, 

or  External  Mammary  Artery. 
10.  The  Thoracica  Acromialis,  or  Humera- 
ria. 

*  .Axillary  Artery.  If  we  have  to  turn  up  the  edge  of  the 
Pectoralis  Major,  to  tie  the  axillary  artery,  we  find  the  artery 
on  the  inside  of  the  coraco  brachialis;  the  external  cutaneous 
nerve  is  on  the  outside  of  the  artery,  the  radial  nerve  on  the 
inside,  and  the  muscular  spiral  below  it;  the  vein  is  betwixt  the 
artery  and  the  muscle;  higher  up  in  the  axilla  the  artery  is  in- 
volved in  the  plexus. 

These  descriptions  of  the  exact  seat  of  the  arteries,  are  in- 
tended to  enable  the  surgeon  to  avoid  them  as  well  as  to  cut 


55 

The   Thoracica  Maris   is   not  in   this 
subject. 

11.  The   Subscapular  Artery;  it  is  seen  to 

divide  upon  the  edge  of  the  Scapula, 
into  a  deeper  and  a  more  superficial 
branch. 

12.  The  Posterior  Circumflex  Artery  of  the 

arm. 

13.  The  Anteinor  Circumflesc  Artery  of  the 

arm. 
In  the  Arm. 

14.  The  Trunk  now  assumes  the  name  of 

Humeral  Ai'tery;*  it  gives  off  these 
branches: 

upon  them  and  take  them  up.  By  attending  to  the  above  cir- 
cumstances, I  cut  a  ragged  ball  out  from  behind  the  artery  and 
nerves  without  hurting  either.  White's  Cases  by  Gun-shot. 
Princifiles  of  Surgery^  292. 

*  The  Humeral  Artery  does  not  run  a  perfectly  straight 
course  down  the  arm.  When  the  subject  is  laid  on  its  back,  the 
arm  by  the  side,  and  the  palm  of  the  hand  flat  upon  the  table,  if 
we  push  a  point  horizontally  under  the  arm-bone,  one  hand's 
breadth  from  its  head yVonz  tvithout,  the  artery  escapes.  When 
in  the  same  horizontal  direction,  two  hand's  breadth  from  the 


56 

15.  The  Superior,  or  Ch'eater  Vrof  Hilda. 

16.  The  Lesser  Profunda. 

17.  The  Anastamoticiis  Major;  tlie  lesser 

anastamosing*  hranch  comes  oft'  high- 
er up,  and  follows  the  same  direction 
round  the  inner  condyle. 
Arteries  of  the  Fore  Arm. 

Extremity  of  the  Humeral  Artery.  The 
Artery  divides   three  fourtlis  of  an 

head  of  the  bone,  the  artery  is  transfixed.  Lower  down  the 
arm,  it  again  rises  towards  the  fore  part  of  the  humerus. 

To  find  the  Humeral  Artery  before  passing  over  the  elbow 
joint,  we  make  the  patient  bend  his  arm  against  a  force,  to 
show  the  expansion  of  the  biceps.  Having  marked  its  place,  we 
put  the  arm  into  a  relaxed  position,  and  make  an  incision  along 
the  inner  edge  of  the  biceps,  or  rather,  we  might  say,  just 
where  it  begins  to  throw  off  its  tendinous  expansion,  two  fin- 
gers' breadth  from  the  inner  condyle  of  the  os  humeri,  carrying 
it  upwards.  We  find  here  not  immediately  the  artery,  but  the 
radial  nerve  covering  the  artery;  laying  this  aside,  we  find  the 
artery  lying  betwixt  its  two  venae  comites. 

I  have  found  on  dissection,  that  the  surgeon  had  included 
the  radial  nerve  in  the  ligature  of  the  humeral  artery.  I  have 
also  found  that  he  had  put  the  ligature  about  the  radial  nerve, 
mistaking  it  for  the  humeral  artery. 


57 

inch  below  the  part  of  the  Medean 
Basilic  Vein,  wliere  we  generally 
bleed. 

18.  IS.  The  Radial  ^irtery. 

19.  19.  The  Ulnar  Artery. 

The  Interosseous  .\rterj,  which  divides 
into  the  Inner  and  Outer  Interosseous. 

The  Recurrent  Arteries  from  these  last 
are,  the 

Becurrens  Badialis  Jlnterior. 

Becurrens  Ulnaris  Anterior. 

Becurrens  Ulnaris  Posterior. 

Recurrens  Interossea. 
20.  At  this  point  the  Radial  Artery  turns 
under  the  supinator  tendon  and  ex- 
tensor tendons  of  the  thumb.* 

*  To  find  the  Radial  Artery  in  its  course  one-third  down  the 
arm,  cut  on  the  outer  edge  of  the  supinator  lo?igus^  first  through 
the  third  fascia — then  lift  the  edge  of  the  muscle,  and  under  the 
second  fascia  you  find  the  radial  artery,  passing  over  the  tendon 
of  they^rowa^or  teres, 

1.  To  take  up  this  artery  on  the  wrist,  we  cut  a  quarter  of  an 
inch  from  the  radial  edge  of  the  Flexor  Carfii  Radialis.  N.  B. 
The  insertion  of  the  Supinator  Radii  Longus  is  on  the  outside, 
but  flat,  giving  no  mark  outwardly.  The  Extensor  Primi  In- 

H 


58 

Superficial  Artery  of  the  Palm. 
21.  The    Ulnav  Artery   passing  over    the 
wrist.* 
Lovsalis  Ulnai'is. 

ternodii  Policis  comes  obliquely  over  the  head  of  the  Radius, 
and  the  insertion  of  the  Supinator. 

A  fascia  covers  the  artery  here.  A  small  nerve  (from  the 
external  cutaneous)  runs  above  the  fascia. 

2.  To  cut  for  the  Radial  Artery,  when  it  has  passed  from  the 
fore  part  of  the  wrist,  we  carry  the  knife  on  the  outside  of  the 
insertion  of  the  Extensor  Radialis  Longior^  and  the  inside  of 
the  Extensor  Tertii  Internodii  Policis.  Betwixt  these  tendons 
the  artery  lies  very  deep,  and  over  it  the  extreme  branch  of  the 
Muscular  Spiral  JVerve. 

*  Ulnar  Artery.  1.  In  the  middle  of  the  fore  arm  the  artery 
lies  under  the  fascia,  and  under  the  margin  of  the  Flexor 
Ulnaris  and  Flexor  Digitorum  Sublimis,  rather  more  under  the 
margin  of  the  last.  To  tie  the  artery,  we  would  have  to  cut 
down  betwixt  these  muscles.  The  Ulnar  JVerve  lies  on  the 
ulnar  edge  of  the  artery. 

2.  To  cut  for  the  Ulnar  Artery  near  the  wrist.  We  carry  the 
knife  upon  the  inside  of  the  Flexor  Ulnaris  Carpi;  we  raise  the 
fascia,  which  binds  down  the  tendon;  but  still  we  have  another 
layer  of  the  fascia,  under  which  the  artery  and  its  Ventje  Cornites 
lie.  The  nerve  is  lying  still  more  under  the  tendon  of  the 
ulnaris  than  the  artery,  but  close  upon  it. 

Ulnar  Artery  tied  for  wound  of  the  palm.  Princifiles  of  Sur- 
gery, 183. 


59 

Arteria  Palmaris  Profunda  Ulnaris. 

22.  The  Great  Palmar  Arch,  from  which  the 

Arteries   of  the  fingers   are  seen  to 
proceed. 

23.  This  dotted  line  marks  the  seat  of  the 

Lesser  Arch  under  the  tendons. 


FIG.  11. 

From  this  Sketch  of  the  Arteries  we  can  follow 
in  idea  their  continued  course  among  the 
muscles. 


EXPLANATION 


OF 


ADDITIONAL  PLATE  VI. 


A.  Arte^na  Radialis. 

B.  Ramus  Borsalis, 

c.  Palmar  is  Fvofunda. 

D.  Ramus  ad  Indicem. 

E.  Ramus  ad  PoUicem. 


ur 


^vS#? 


EXPLANATION 


or 


PLATE  VII. 


THE  mSTRIBUTIOJ^r  OF  THE  CCELMC 
ARTERY. 

(Bell,fiages  412—422.    Wistar,  276-^280.) 

A.  The  Liver  raised  so  as  to  show  its  concave 

surface. 

B.  The  Gall  Bladder. 

c.  The  Stomach  laid  down  to  the  left  side, 

D.  The  Omentum. 

E.  The  Colon. 

p.  The  Small  Intestines, 

1.  The  Jlorta. 

2.  The  Root  of  the  Coeliac  Artery. 


64 

3.  The  Superior  Coronary  Artery  of  the  Sto- 

mach. 

4.  The  Splenic  Artery. 

5.  The  Gastro -Epiploic  Artery, 

6.  The  same   Artery  running  upon  the  great 

Arch  of  the  Stomach. 

7.  The  Pancreatica  Buodenalis,  a  branch  of  the 

last. 

8.  The  Hepatic  Arter'y;  it  is  seen  to  divide  into 

the  right  and  left  hepatic  arteries;  the 
right  hepatic  artery  is  seen  to  give  oft' the 
Cystic  Artery;  a  small  branch  is  seen 
passing  from  the  trunk  of  the  hepatic  ar- 
tery to  the  Pylorus,  viz.  the  Lower  Pyloric 
Artery, 


/'/,Uf  iv/y. 


I  '   ^  ^• 


/A  ;^v/  ,/,•/, 


Ly.  C,/ir/i,     .t,ri//l. 


JhiHirhd  M>K  /S/L'  ^r  J.rir/n   J'M^aif 


EXPLANATION 


PLATE  VIII. 


THE  MESEJSTTERIC  ARTERIES, 

(Bell,  page  422.    Wistar,  pages  280 — 285.) 

A.  A.  The  Omentum  held  up,  and  bearing  the 

great  Arch  of  the  Colon. 

B.  The  termination  of  the  Intestinum  Ileon  in 

the  Caput  Coli. 
c.  Caput  Coli. 
D.  E.  The  Jlrch  of  the   Colon,  which  stretches 

across  the  belly. 

F.  The  Sigmoid  Eleacuve  of  the  Colon. 

G.  The  Rectum. 

H.  The  Bladder  of  Urine. 

I 


66 

1.  The  Aorta. 

2.  The  Coeliac  Artery, 

3.  The  root  of  the  Upper  Mesenteric  Artery. 

4.  Tlic  great  Lash  of  Arteries  which  go  to  the 

small  intestines. 

5.  The  Ileo-Colic  Artery, 

6.  The  Bight  Colic  Artery. 

7.  The  Middle  Colic  Artery, 

8.  The  Lower  Mesenteric  Artery, 

•  9.  The  Left  Colic  Artery;  this  forming  a  great 
inosculation  hctwixt  the  Upper  and  Lower 
Mesenteric  Arteries. 

10.  The  llcvmorrhoidal  Artery  descending  with 

the  Rectum  into  the  Pelvis. 

1 1.  Tlie  Emulgent  Artery  of  the  left  side. 

12.  Tlie  Spermatic  Artery. 

13.  The  Middle  Sacral  Artery. 

14.  The  Common  Iliac  Artery. 

15.  The  Eccternal  Iliac  Artery. 

16.  The  Internal  Iliac  Artery. 


t/>iu-  J. v. 


■r. :  y^ 


Sj 


{i  /i//  ,t.^. 


^.  SM„<  ^.y,//, 


EXPLANATION 


PLATE  IX. 


OF  THE  ARTEEIES  OF  THE  LOWER 
EXTREMITY, 

(Bell,  page  452.    TVistai;  fiages  291 — 300.) 

A.  The  Tendon  of  the  External  Oblique  Muscle. 

B.  The  Sartorius  Muscle. 
c.  The  Gracilis. 

D.  The  Triceps  Muscle. 

E.  The  Rectus  Femorls. 

F.  The  Vastus  Internns.  ^^ 

G.  The  Vastus  Externas.  \; 
H.  The  Patella. 

I.  The  Tibia. 

K.  The  Head  of  the  Fihula. 

L.  The  Gastrocnemius  Muscle. 


68 

M.  The  Solens  Muscle, 

N.  The  Tibialis  Anticus. 

o.  Tlie  Extensov  Tiudous  of  the  Toes. 


AnTEBIES. 

1.  The  Femoral  Artery. 

2.  The  Epigastric  Artery.* 

*  Rfiigastric  Artery.  This  artery  passes  in  a  direction  to- 
wards the  RectJis  Abdominis,  behind  the  spermatic  cord;  it  is 
consequently  behind  the  neck  of  the  sac  in  bubonocele  Thou}3;h 
rarely,  yet  sometimes  it  happens  that  the  hernia  conies  down 
behind  the  spermatic  cord,  or  nearer  to  the  pubes,  or  even  so 
as  to  split  and  separate  the  vas  deferens,  from  the  other  sper- 
matic vessels;  in  this  case  the  epigastric  artery  lies  on  the  in- 
side of  the  sac  I  have  seen  this  artery  cut  in  the  operation  for 
hernia.  Ic  has  been  opened  in  the  operation  of  Paracentesis 
Abdominis',  and  the  patient  lost  by  a  hxmorrage  into  the  belly. 

Very  often  a  considerable  branch  of  this  artery  courses  along 
the  edge  of  the  Poupart  ligament,  towards  the  pubes.  Its  com- 
mon distribution  is  thus: 

1.  To  the  cord  and  cremaster  muscle. 

2.  Towards  the  back,  of  the  os  pubis. 

3.  Principal  branch  ascending  upon  the  rectus. 

4.  Inosculating  with  the  internal  mammary. 


69 

3.  The  Jlefiexa  Ilii. 

4.  A  Cutaneous  Branch  to  the  head  of  the  Sar- 

torius,  and  g-lands,  and  fat. 

5.  To  the  Inguinal  Glands,  and  Fat;  it  sends 

out  a  pudic  branch  also. 

6.  The  External  Pudic  Jlrtery.* 

7.  The  Profunda. 

8.  The  Internal  Circumjlecc  Artery. 

9.  The   Profunda,    proceeding    deep   into   the 

flesh  of  the  thigh  before  it  gives  off  the 
perforating  branches. 
The  Branches  of  the  Profunda  are  seen  in  the 
interstices  of  the  Rectus  and  Yastus  Ex- 
ternus.f 

*  The  largest  of  these  External  Pudic  Arteries  gives  out  its 
blood  freely,  when  cut  in  the  operation  of  vScrotal  Hernia,  or 
extirpation  of  the  testicle. 

t  They  are  these: 

'To  the  Dorsum  Ilii. 
To  the  outside  of  the  hip. 
The  greater  and  lesser  descending 
branches. 


Arteria  Circumflexa 

Externa' 


Interna. 


70 

10.  The  Femoral  Artery,  where  it  lies  betwixt 
the  triceps  and  vastus  internus  muscle, 
before  it  perforates  the  triceps.* 

ll,t  12,  13.  Articular  Arteries,  branches  of  the 
Popliteal  Artery. 

14.  The  Anterior  Tibial  Artery.X 

*  Femoral  Artery.  This  artery,  near  the  place  of  its  perfora- 
ting the  triceps,  is  the  subject  of  one  of  the  most  important 
surgical  operations,  for  popliteal  aneurism.  In  dissection  it  may 
be  well  to  make  this  experiment:  Place  a  string  so  as  to  reach 
from  the  superior  spine  of  the  os  ilii  to  the  prominent  part  of 
the  inner  condyle;  mark  the  middle  of  the  string;  make  an  in- 
cision a  very  little  towards  the  inside  of  it,  in  the  direction  of 
the  string;  first,  you  come  to  the  sartorius  muscle;  next,  lay- 
ing that  aside,  to  a  fascia,  which  stretches  from  the  triceps  to 
the  vastus  internus;  when  this  is  slit  up  you  may  see  the  artery; 
observe  its  situation  in  regard  to  the  -vein^  the  ncrvus  longus, 
and  the  sheath  which  surrounds  it. 

t  This  branch  (the  first  perforating  branch  of  the  Popliteal 
Artery)  is  remarkably  enlarged  in  Popliteal  Aneurism. 

\  The  Anterior  Tibial  Artery  lies  so  under  the  projection  of 
the  Tibia,  that  it  is  not  often  wounded;  yet  it  may  be  cut  by  a 
deep  wound,  and  the  student  should  observe  how  it  lies  under 
the  fascia  and  muscles. 

«  The  Anterior  Tibial  Artery  comes  through  betwixt  the 
"  bones,  one  inch  below  the  projection  of  the  knob  of  the  Fibu- 
"  la;  we  then  cut  by  the  edge  of  the  Peroneus  Longus,  and  fol- 


71 

15.  The  Reflected  Branch  of  the  Anterior  Ti- 

bial Artery. 

16.  The  Jlnterior  Tibial  Artery^  continuing  its 

course,  and  distributing  small  branches  to 
the  surrounding  muscles. 

17.  At  this  part  it  passes  under  the  Annular 

Ligament. 

18.  The  Internal  Maleolav  Artery. 

19.  The  Eccternal  Maleolar  Artery. 

20.  The  Tarsal  Artery. 

21.  The  Anterior  Tibial  Artery  descending  on 

the  fore  part  of  the  foot. 

22.  The   part   at  which  the   Anterior   Tibial 

Artery  sinks  into  the  sole  of  the  foot, 
formuig  communications  with  the  Plantar 
Arteries. 

23.  The   last  branch  of  the  Anterior  Tibial 

Artery,  the  Arteria  Borsalis  Pollicis. 

« low  the  partition  fascia,  which  is  betwixt  this  muscle  and 
"  the  head  of  the  Extensor  Digitorum  Communis.  This  parti- 
«  tion  carries  us  deep,  and  we  find  the  artery  lying  on  the  in- 
"  terosseous  ligament." 

When  the  artery  is  to  be  tied  lower  down,  after  slitting  up 
the  fascia,  we  must  cut  betwixt  the  Tibialis  Anticus,  and  Ex- 
tensor Pollicis. 


ri,Uc  X 


1/    °\. 


/ 


I  h 

/  ^    / 


■7K>^ 


^P  •; 


ci/f,-//  M. 


iy.    Oc/f/f//     .III////. 


EXPLANATION 


OF 


PLATE  X. 


(^Bellj/iage  442  to  the  end.    IVistar,  291 — 300.) 

A.  The  body  of  the  last  Lumbar  Vertebra  sa'vvii 

through. 

B.  The  Sacrum. 

c.  Ischiatic  Ligaments, 

D.  The  Lumhar  Muscles. 

E.  The  Great  Gluteus  Muscle. 

F.  The  Lesser  Gluteus  Muscle. 

G.  The  Gracilis  Muscle. 

H.  The  Vastus  E^rternus  Muscle. 

I.  The   Outer  Hamstrhig   Muscles;    i.  e.    the 

Biceps. 
K.  The  Inner   Hamstring  Muscles,  i.  e.    the 

Semi-tendinosus  and  Semi-memhranosus. 

K 


74 

L.  L.  The  Triceps. 

M.  The  Outer  Condyle  of  the  Thigh  bone. 
N.  The  Inner  Condyle, 
o.  The  Belly  of  the  Gastrocnemius  Muscle. 
V.  The  Soleus  Muscle. 
Q.  The  Achilles  Tendon. 
R.  The  Tibia. 

s.  The  Great  Flexor  Pollicis. 
T.  The  Flexor  Digitorum  Coniraiinis. 
1.  The  Internal  Iliac  Artery;  giving  off, 
2.  Hypogastric  Artery. 

3.  3.  Ischiatic  Artery.* 

4.  4.  I'he  Pudic  Artery. 

*  To  hit  upon  the  Ischiatic  Artery  as  it  comes  out  from  the 
Pelvis,  begin  the  incision  by  the  side  of  the  Sacrum,  three 
fingers  breadth  from  the  posterior  spinous  process  of  the  Ilium, 
and  carry  it  down,  in  the  length  of  the  fibres  of  the  Gluteus 
Maxinius,  to  the  outside  of  the  tuberosity  of  the  Ischium. 
Even  in  a  thin  man,  the  artery  lies  two  inches  deep.  Now,  push- 
ing in  the  finger  as  if  under  the  sacrum,  we  there  feel  the  acuta 
edge  of  the  sacro-sciatic  ligament;  on  the  lower  margin  of  the 
sacro-sciatic  hole,  (which  is  distinctly  felt  with  the  finger 
amongst  the  looser  parts,)  the  autery  is  felt  crossing  the 
LIGAMENT  OBLIQUELY;  ucar  it,  upou  its  outer  side,  are  some 
LESSER  nerves;  the  great  Sciatic  Nerve  is  removed  an  inch 
from  it. 


75 

5.  The  Obturator  ^rtery.^ 

6.  6.  The  Gluteal  Artery.^ 

7.  A  branch  from  the  Internal   Clrciimjiea; 

Artery, 

8.  Branches  of  the  Perforating  Arteries  of  the 

Frofumla. 

9.  The  Popliteal  Artery  after  it  has  pierced 

the  Triceps  Muscle.J 

*  We  see  here  what  would  be  the  situation  of  the  Obturator 
Artery^  if  a  Hernia  should  descend  under  Poupart's  ligament 
in  a  person  having  this  distribution  of  the  vessel.  See  Cooper 
on  Hernia. 

t  To  strike  upon  the  Gluteal  Artery,  we  cut  in  the  di- 
rection of  the  fibres  of  the  Gluteus  Maximus,  beginning  about 
TWO  fingers'  breadth  beneath  the  posterior  spine  of  the  Ilium; 
we  cut  through  the  Gluteus  Maximus  and  Medius  just  upon 
the  lower  edge  of  the  Ilium;  we  find  the  trunk  of  this  artery 
rising  to  mount  upon  the  back  of  the  Ilium;  we  must  observe, 
too,  that  CONSIDERABLE  branches  are  carried  outwards 
through  the  muscle,  into  which  we  must  cut  to  arrive  at  the 
seat  of  the  trunk. 

In  case  of  a  wound  in  this  artery,  and  the  consequent  for- 
mation of  a  false  Aneurism,  the  surgeon,  after  puncturing  the 
tumour,  has  to  push  his  finger  deep  amongst  the  blood  until 
he  arrive  at  the  trunk  over  the  notch  of  the  Ilium — compress- 
ing it  there,  he  may  gain  time. 

^  The  Popliteal   Artery  wounded  by  a  sabre;   Princifiles  of 


76 

10.  Those  branches  sent  oft'  from  the  main  ar- 

tery as  it  is  passing  the  Tendon;  they  are 
called  the  peribrating  branches  of  the 
Poplitel    Artery. 

11.  The  Upper  and  Inteinial  Jlvlicular  Artery. 

12.  The  Upper  Ejcternal  Articular  Artery. 

13.  The  Lower  Ejcternal  Articular  Artery. 

14.  The  Lozver  Internal  Articular  Artery. 

15.  The  Posterior  Tibial  Artery;  the  Anterior 

Tibial  Artery  (Plate  IX.  16.)  is  a  branch 
sentofi'from  this.* 

16.  The  Peroneal  Artery,  or  Fibular  Artery,  f 

Surffery,  328 — wounded  by  the  sharp  projection  of  the  femur 
after  fracture:  0/ierative  Surgery,  ii.  357, 

*  Posterior  Tibial  Artery  gives  off  the  outer  Tibial;  piercing 
betwixt  the  heads  of  the  bones  exactly  four  fingers'  breadth 
below  the  upper  end  of  the  Tibia;  lying  upon  the  Popliteus 
Muscle,  it  is  about  two  fingers  breadth  removed  from  the  inner 
edge  of  the  Tibia. 

t  Fibular  Artery.  It  comes  through  the  bones  one  inch  below 
the  projection  of  the  knob  of  the  Fibula.  To  hit  upon  it,  1.  We 
cutthrough  the  strong  fascia.  2.  Betwixt  the  heads  of  the  Ex- 
tensor  Digitoriim  L,ongus,  and  of  the  Peroneus  Longus,  we 
find  it  lying  on  the  interosseous  ligament.  N.  B.  We  must  cut 
thi'ough  some  of  the  fibres  of  the  Extensor  Digitorum  Longus. 

To  cut  for  the  Fibular  Artery  lower  in  the  leg  than  a  hands* 


77 


17.  The  Posterior  Tibial  Artery  appears  here 
again  from  under  the  Soleiis  Muscle.* 

breadth  from  the  head  of  the  Fibula.  1.  The  fascia.  2.  By  the 
outside  of  the  Tibialis  Anticus;  betwixt  it  and  the  Extensor 
Profirius  Pollicis. 

It  seems  a  shocking  alternative  to  be  obliged  to  saw  out  the 
Fibula,  in  order  to  tie  this  artery.  To  find  this  artery  two  hands' 
breadth  from  the  heel,  cut  down  on  the  outside  of  the  Gastroc- 
nemius, where  it  is  becoming  tendinous;  turn  up  the  edge  of 
the  tendons;  you  then  find  the  Flexor  Pollicis  Magnus  covered 
with  its  sheath.  If  you  seek  for  the  Fibular  Artery,  by  going 
deep  into  the  leg  without  piercing  this  fascia,  you  find  the  Tibial 
JVerve^  and  may  come  on  the  Tibial  Artery.  To  find  the  Fibu- 
lar, then,  we  cut  down  by  the  side  of  the  bone  (fibula),  and  raise 
the  fibrous  origins  of  the  Flexor  Pollicis.  We  then  find  the 
artery  by  the  acute  edge  of  the  bone,  lying  on  the  ligament, 
accompanied  only  by  its  Venae  Comites. 

*  The  Posterior  Tibial  Artery.  For  complicated  wounds  in 
the  sole  of  the  foot,  this  artery  may  require  to  be  taken  up  be- 
hind the  ancle  joint,  and  before  it  pierces  under  the  Flexor 
brevis  pollicis  pedes.  We  shall  be  directed  to  the  exact  place, 
by  observing  the  lowest  projecting  part  of  the  Tibia.  The  ten- 
dons, which  run  close  upon  this  tuberosity  of  the  bone,  are  the 
Tibialis  Posticus,  and  Flexor  Communis;  the  first  lies  so  close- 
ly braced  to  the  bone  in  its  particular  sheath,  that  it  will  not  be 
observed;  the  artery  runs  a  little  nearer  the  heel  than  the  ten- 
don of  the  Flexor  Communis;  a  fascia  braces  down  the  artery, 
the  nerve  is  under  the  artery. 


78 

18.  The  Fibtilai'  Jlrtery;  it  is  seen  to  form  large 

inosculations  with  the  Tibial  xlrtery. 

19.  A  remarkable  inosculation  betwixt  the  Ti- 

bial and  Fibular  Arteries. 

20.  The  Ejctemal  Plantar  Ai^tery. 

21.  The  Internal  Flantar  Artery. 


^ 


Date  Due 

1 

Form   335— 40M— 6-40 

^ 


611.13  B433E 


424263 


^^  .V 


r:^^^* 


